Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
"Do I Really Need a Colonoscopy?" If You're Over 50, The Answer Is Yes
Posted in Colon Cancer by Dr. Sharon Orrange on Apr 21, 2011
Yes, you do. The lifetime risk of colorectal cancer is 6%. Let’s first assume you have no symptoms, are < 50 years old, and have no family history... you do not need a screening colonoscopy. If you are over 50 you need one. This is true whether or not you have symptoms and whether or not your annual stool test is negative, and that is the standard of care. I know a colonoscopy is no small deal but you may be convinced to have one when I show you why.

The average risk population needs their first screening colonoscopy at age 50. If you have a family history you will get yours either at age 50, or 10 years prior to your family members' diagnosis (so if your father was 48 when he was diagnosed you get one at 38).

Sub-standard colon cancer screening is still practiced in some areas. An annual fecal occult blood test (where a sample of stool is placed on a card and a liquid solution is added to see if it turns blue indicating microscopic blood in the stool) & flexible sigmoidoscopy every 3-5 years is still done in some areas. Flexible sigmoidoscopy is an easier procedure because it can be done in the office without the sedation they use for colonoscopy, yet it can view only the lower third of the colon. Why do I want my patients to undergo a procedure where I can tell them this: “well, the lower third of your colon looks great.” Hmmmm, and the rest?

For your screening colonoscopy you need to find a gastroenterologist who performs them all the time. The colon preparation the day before is truly a bummer as you will be pooping water by the end of the night. You will receive twilight anesthesia not general anesthesia and won’t remember much of anything.

What about the virtual colonoscopy (CT colonography)? This is a CT scan with radiation used to image the colon where a colon preparation/cleanse is still involved. Virtual colonoscopy is not yet recommended as a screening tool because of the cost, and the fact that if a colon polyp is seen, you will still have to have a colonoscopy for removal. Compare this to your gastroenterologist seeing a polyp during your colonoscopy and removing it right there. One procedure.

Colon cancer deaths dropped for the first time 4 years ago and that is because of screening colonoscopy. This will amaze you; look how it compares in cost per year of lives saved to other screening procedures:

Colonoscopy every 10 years: $6,600

Breast cancer screening: $22,000

Heart transplantation: $160,000

Cervical cancer screening: $250,000

Convinced? Embrace the colon- cleanse you have to do prior to your procedure because when you find out your colonoscopy is normal, you are in the clear for 10 years.

Dr O.

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No you do not. I have never had, and will never have any form of invasive treatment. There are numerous studies that show these unneccessary tests do not significantly improve cancer survival. Even if they did I would never submit to one. I'll take my chances
By yiyayiya  Apr 13, 2012
I had one at age 40 for rectal bleeding. One small polyp removed and a recommendation to come back every 3 years "just in case". I'm now 50 and I still won't go back.


1) for a 50 year old man, according to the Center for Disease Control, there is only a 0.7% chance of colon cancer in the next 10 years; 2.04% chance over the next 20; 3.86% chance over the next 30. In other words, there is a 99.3% chance of no cancer in the next 10 years and 96.14% chance of none all the way to age 80. Those are pretty good bets. A good 1/3 of people have polyps in midlife so that's not that big of a deal.

2) on the other hand...there is approximately a 5/1000 chance of serious complications from a colonoscopy - more if a polyp is removed. The chance of a serious - even life threatening - complication is 0.5% -- almost as much risk as there is in developing cancer over the next 10 years. That's a big percentage.
By dcinma  Oct 24, 2011
3) When I had the procedure, there wasn't much too it honestly other than the prep. I even remember waking up during the middle of it to watch the polyp excised. However....there is a 100% chance of being humiliated by this procedure. I do not now and never will expose myself to this sort of humiliation again. As a man, it is impossible to have this procedure without having your private parts exposed to members of the opposite sex. Women usually can get an all female team. I don't allow my male doctor to perform intimate exams; I'll be damned if I expose myself like that to a group of women again. I don't go to the ladies room ... I don't see why I should have to expose myself to this sort of embarrassment either.

Think hard before going through this dangerous, expensive, humiliating -- and usually unneccesary procedure.
By dcinma  Oct 24, 2011
Unfortunately, I do not agree with all this "preventive" treatment rubbish. I have been told that I should be getting regular colonoscopy, endoscopy and prostrate exams. I have refused to have any and all of these and will continue to do so. I have even set up an advanced directive prohibiting these and many more treatments should I be incapable. If and when the time comes when I think I need them, i will re-evaluate. Dont be forced into having treatments because health people say you have to have them. You say what happens to your body, noone else.
By yiyayiya  Jul 13, 2011
very serious business indeed. i had a routine colonoscopy at age 50. two pollyps were excised.
By capnhardass  Apr 25, 2011
DR O: Thanks for the comment about the MAC anesthesia. I had the "twilight sedation" during my last c-scope and woke up partway through it. I dimly remember the nurse throwing her body across mine and screaming at me, "DON'T MOVE!"

The sedation numbs the part of your brain that allows you to think rationally, so you are unable to tell yourself, "Yes, it hurts, but stay still. Otherwise, something might get perforated and that would be bad."

Only the primitive part of your brain is still on duty and all it knows is "PAIN! MOVE! NOW!"

I'm glad to know that a deeper form of anesthesia is available.
By madbookworm  Apr 23, 2011
Thanks Guti for your post and we are so sorry for your loss.I am about to lose another of many patients with metastatic colorectal cancer who didn't have screening and unfortunately didn't have a primary care doctor who recommended screening....she's only 56.
By DrOrrange  Apr 23, 2011
A colonoscopy would have saved my dad's life! My mom kept telling him to get one but since he was "feeling fine" he just put it off. Later there were some dangerous signs that had to be checked out. And then, finally, the diagnosis. Cancer. Rectal cancer. A tumor, a huge one. What was dad's first question? "Could this have been prevented with a colonoscopy?" The doctor told him it was a little late to ask now! He had to his bowel removed. He died six months after his diagnosis. Please take the step of prevention.
By Guti  Apr 23, 2011
Thanks everyone for this info!

Comment six a product promotion unrelated to the topic and should be deleted.

Is this not a violation of the terms of being a ember of this board?

miguelglass: Did you just join today in order to post this junk?
By rossid  Apr 23, 2011
Look up Dave Barry's column about his experience with colonoscopy. It's not only howlingly funny, it's remarkably accurate.

The prep is nasty and the procedure, fortunately, is done with sedation these days, so it isn't too bad. You just have to remind yourself that colon cancer would be infinitely nastier.
By madbookworm  Apr 23, 2011
Well one thing I have to disagree with in your article is, that I have no family history and had no symptoms and was just diagnosed with stage 3 colon cancer. So it is not true that you don't need a screening if you have no family history until the age of 50. Since my diagnosis I have met so many people in a support group who are way under 50 with colon cancer, there really needs to be screening way earlier for this horrible disease.
By loricolt  Apr 22, 2011
Trudilu in cases like yours, we use MAC Anesthesia (Monitored Anesthetic Care) which is not general anesthesia but more than the conscious sedation you received.
Dr O.
By DrOrrange  Apr 22, 2011
I attempted to have a colonoscopy 2 years ago at the same time I was having an endoscopy for diagnosis of a hiatal hernia. I was sedated and they also told me I would not remember a thing.

One second into the procedure, it was so excruciatingly painful that they had to stop. I was literally crying from the pain. I wanted one, but it could not be performed with the medication I was given.

I am taking a substance called suboxone which lowers my tolerance to pain, so I don't know if that had something to do with it. Is it possible to having a colonoscopy under general anesthesia. I know there are risks associated with anesthesia, but I couldn't get through it the last time.

How am I supposed to get these necessary tests when they are too painful to endure?

By Trudilu  Apr 22, 2011
Thanks for the information, but the age should be lowered. My dad died at 44 of colon cancer. I hear it's harder to get a colonoscopy when you're not over 50.
By imperfectdiamond25  Apr 22, 2011
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